Canada - World Health Organization Regional Office for Europe

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Health systems in transition Canada
The majority of PHI comes in the form of employment-based group policies
that are benefit plans sponsored by employers, unions, professional associations
and similar organizations (Hurley & Guindon, 2008). Since this type of
insurance “comes with the job”, it is not “voluntary”. Canadians receiving or
purchasing PHI are exempt from taxation on these benefits or premiums by the
federal government and all provincial governments except Quebec.
Almost all PHI in Canada would be classified as complementary to medicare
(Hurley & Guindon, 2008). PHI that attempts to provide a private alternative to
medicare (substitutive PHI) or faster access to medicare services (supplementary
PHI) is prohibited or discouraged by a complex array of provincial laws and
regulations. Six provinces – British Columbia, Alberta, Manitoba, Ontario,
Quebec and Prince Edward Island – and three territories prohibit the purchase
of PHI for medicare services. In the remaining four provinces, the purchase of
PHI for such services is discouraged through various means, in particular by
not allowing physicians to work in both public and private systems at the same
time (Flood & Archibald, 2001; Marchildon, 2005).
Until recently, PHI has received relatively limited policy attention because
it has been restricted to complementary insurance – covering those services not
included in medicare (Hurley & Guindon, 2008). In the wake of a 2005 ruling
by the Supreme Court of Canada that Quebec’s law prohibiting supplementary
insurance for medicare services violated Quebec’s Charter of Rights in the
presence of excessive waiting times for non-emergency surgery, there have
been repeated calls by market advocates for PHI for medicare (Flood, Roach
& Sossin, 2005; Flood, 2007).
3.6 Social insurance
Of the remaining sources of finance, the single most significant is social
insurance funding from provincial workers’ compensation schemes. Health
benefits for work-related injuries and sickness under provincial workers’
compensation plans pre-date the introduction of medicare, with the first such
scheme introduced by British Columbia in 1917. Administered by provincial
WCBs, these benefits are paid for by compulsory employer contributions that
are set by provincial law. WCB payments for health services were estimated to
be C$1.4 billion, roughly 1.5% of public health expenditures (Marchildon, 2008).
Much of this is paid directly to provincial health authorities and individual
health facilities and providers.